Program Operations Manual System (POMS)

In addition to providing coverage for 100 home health visits in a calendar year prior to July 1, 1981 (see HI 00610.400), SMI provides reimbursement for “medical and other health services”. When a beneficiary with Part B coverage has exhausted his home health benefits prior to July 1, 1981 or is not entitled to home health benefits, reimbursement may be made to a HHA which furnishes either directly or under arrangements with others the following “medical and other health services” which would constitute reimbursable home health services if furnished under a home health plan to an eligible beneficiary:

Prosthetic devices (other than dental) which replace all or part of an internal body organ (including contiguous tissue) or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ. Replacements or repairs of such devices are covered when furnished incident to a physician's services or on a physician's order.

Arm, leg, neck, and back braces, and artificial legs, arms, and eyes including replacement for such due to a change in the patient's physical condition. A brace includes rigid and semi-rigid devices which are used for the purpose of supporting a weak or deformed member or restricting or eliminating motion in a diseased or injured part of the body.

Physical therapy and speech pathology provided to outpatients by any participating provider of services are covered as a “medical and other health service.” An individual is not required to be homebound to be eligible for this benefit. Thus, an HHA, or any other provider, can furnish outpatient physical therapy and speech pathology services to a patient whose condition is not such as to render the patient “homebound” for purposes of receiving home health services if he had Part B coverage. In addition, an HHA or any other provider can furnish and receive reimbursement for outpatient physical therapy services and outpatient speech pathology services provided to a patient who is not receiving or, prior to July 1, 1981, has exhausted his home health benefits or has elected to receive the services as “medical and other health services” rather than home health services (see HI 00610.420).

Rental or purchase of durable medical equipment for use in the patient's home.

NOTE: Ambulance service is a “medical and other health service” which is not covered as a home health service. However, when an ambulance service is operated by or under arrangements made by an HHA, reimbursement for the service (including the cost of oxygen administered in connection with ambulance service) may be made if the requirements for coverage of ambulance service are met (see HI 00610.250).